Provider Demographics
NPI:1457687477
Name:POLLACK-NABER, BRIDGET DANIELLE (MS LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:DANIELLE
Last Name:POLLACK-NABER
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:DANIELLE
Other - Last Name:PLLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 HWY 40 E STE M-128
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6500
Mailing Address - Country:US
Mailing Address - Phone:912-882-7383
Mailing Address - Fax:
Practice Address - Street 1:360 PIERCE AVE
Practice Address - Street 2:SUITE 209 SIOUX TRAILS MENTAL HEALTH CENTER
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003
Practice Address - Country:US
Practice Address - Phone:507-388-3181
Practice Address - Fax:507-388-3199
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001630101YM0800X
MN1794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health